Veterans’ Entitlements Act 1986 and Military Rehabilitation and Compensation Act 2004 Title 1. This Instrument may be cited as Statement of Principles concerning Marfan syndrome No. 26 of 2015. Determination 2. The Repatriation Medical Authority under subsection 196B(3) and (8) of the Veterans’ Entitlements Act 1986 (the VEA): (a) revokes Instrument No. 54 of 2007 concerning Marfan syndrome; and (b) determines in its place this Statement of Principles. Kind of injury, disease or death 3. (a) This Statement of Principles is about Marfan syndrome and death from Marfan syndrome. (b) For the purposes of this Statement of Principles, "Marfan syndrome" means a genetic disorder of connective tissue, heritable as an autosomal dominant trait, characterised by abnormalities of the eyes, bones, heart and blood vessels. (c) Marfan syndrome attracts ICD-10-AM code Q87.4. (d) In the application of this Statement of Principles, the definition of "Marfan syndrome" is that given at paragraph 3(b) above. Basis for determining the factors 4. On the sound medical-scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that Marfan syndrome and death from Marfan syndrome can be related to relevant service rendered by veterans or members of the Forces under the VEA, or members under the Military Rehabilitation and Compensation Act 2004 (the MRCA). Factors that must be related to service 5. Subject to clause 7, at least one of the factors set out in clause 6 must be related to the relevant service rendered by the person. Factors 6. The factor that must exist before it can be said that, on the balance of probabilities, Marfan syndrome or death from Marfan syndrome is connected with the circumstances of a person’s relevant service is: (a) being pregnant before the clinical worsening of Marfan syndrome; or (b) inability to obtain appropriate clinical management for Marfan syndrome. Factors that apply only to material contribution or aggravation 7. Paragraphs 6(a) and 6(b) apply only to material contribution to, or aggravation of, Marfan syndrome where the person’s Marfan syndrome was suffered or contracted before or during (but not arising out of) the person’s relevant service. Inclusion of Statements of Principles 8. In this Statement of Principles if a relevant factor applies and that factor includes an injury or disease in respect of which there is a Statement of Principles then the factors in that last mentioned Statement of Principles apply in accordance with the terms of that Statement of Principles as in force from time to time. Other definitions 9. For the purposes of this Statement of Principles: "death from Marfan syndrome" in relation to a person includes death from a terminal event or condition that was contributed to by the person’s Marfan syndrome; "ICD-10-AM code" means a number assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Australian Modification (ICD-10-AM), Eighth Edition, effective date of 1 July 2013, copyrighted by the Independent Hospital Pricing Authority, and having ISBN 978-1-74128-213-9; "relevant service" means: (a) eligible war service (other than operational service) under the VEA; (b) defence service (other than hazardous service and British nuclear test defence service) under the VEA; or (c) peacetime service under the MRCA; "terminal event" means the proximate or ultimate cause of death and includes: (a) pneumonia; (b) respiratory failure; (c) cardiac arrest; (d) circulatory failure; or (e) cessation of brain function. Application 10. This Instrument applies to all matters to which section 120B of the VEA or section 339 of the MRCA applies. Date of effect 11. This Instrument takes effect from 27 January 2015. Dated this nineteenth day of December 2014 The Common Seal of the ) Repatriation Medical Authority ) was affixed at the direction of: ) PROFESSOR NICHOLAS SAUNDERS AO CHAIRPERSON

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